A Comprehensive, Multidisciplinary Assessment for Knee Osteoarthritis Following Traumatic Unilateral Lower Limb Loss...

Area of Science:

• Orthopedics
• Sports Medicine
• Biomedical Engineering

Background:

• Knee osteoarthritis (KOA) significantly impacts quality of life (QoL) and function in service members (SM) with lower limb loss (LL).
• Identifying and mitigating KOA progression in this population remains challenging.

Purpose of the Study:

• To comprehensively evaluate knee joint health, functionality, and QoL in SM with traumatic LL at the baseline of a prospective study.
• To characterize the prevalence and patterns of KOA in SM with lower limb loss.

Main Methods:

• Cross-sectional evaluation of 38 male SM with traumatic unilateral LL (transtibial and transfemoral).
• Magnetic resonance imaging (MRI) for articular degeneration (Kellgren-Lawrence Grade, Outerbridge Classification), full-body gait analysis for biomechanics, serum immunoassays for 26 protein biomarkers, and patient-reported outcome measures for function and QoL.
• Analysis included Kellgren-Lawrence Grade (n=32) and Outerbridge Classification (n=22) for KOA assessment.

Main Results:

• KOA (KL≥1) was present in 37.5% (12/32) of SM, while patellofemoral degeneration (OC≥1) was found in 72.7% (16/22).
• SM with KOA showed reduced joint space, wider stride width, and altered knee adduction moments compared to those without KOA.
• Elevated pro-inflammatory and collagen breakdown biomarkers, along with reduced hyaluronic acid and bone resorption markers, were observed in SM with KOA. Patient-reported pain correlated negatively with function and QoL.

Conclusions:

• Patellofemoral degeneration is highly prevalent (72.7%) in SM with traumatic LL, suggesting greater susceptibility than the tibiofemoral joint (37.5%).
• These findings highlight the need for targeted interventions for patellofemoral health in SM with lower limb loss.